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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

OIG Work Plan, Complianc Plan, compliance, resources

Workshop Replay: Did you update your Compliance Plan for 2017?

Posted by Donna Thiel on Tue, Jan 31, 2017

It’s that time of year again.  Time to brush the dust off your Compliance Plan and make sure you are monitoring the right areas and make sure you Plan reflects any process changes made in 2016.  Of course, best practice is to routinely review the Compliance Plan and update as needed but just in case, let’s review some basic steps you can take to update your Compliance Plan today.

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Fraud and Abuse, Penalties and Fines, exclusions

50 is the New 20: First 50-Year Exclusion Imposed

Posted by Michael Rosen, ESQ on Thu, Jan 26, 2017

What happens if you are unlicensed, excluded, own a dental practice, bill CMS for federally reimbursed heatlhcare services and submit false claims?  To compare to the game Monopoly, you quickly go past jail and pay $1.1M as well as agree to one of the longest exclusions ever with the OIG.   

OIG alleged that from November 2005 through October 2012, Brookhim owned, controlled, and managed Associated Dental NP, LLC (ADNP), a New Jersey dental practice with multiple locations, in violation of his exclusion from Federal health care program participation in August 2000.

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OIG Exclusion List, OIG, Fraud and Abuse, Penalties and Fines, OIG Exclusion

NOTICE: New OIG Exclusion Authority for Fines and Penalties

Posted by Michael Rosen, ESQ on Tue, Jan 24, 2017

Hey, we don't want to exclude you from the news, so here is the skinny. The OIG has new and expanded exclusion authorities, and as we will outline below, the fines have increased, in some cases double since last year. The Final Rule effective date is February 13, 2017.

On December 6, 2016, the U.S. Dept. of Health and Human Services, Office of Inspector General (OIG) issued rules that incorporate new civil and monetary fines and penalties (CMP) authorities, clarify existing authorities, and reorganize regulations regarding CMP’s. The Final Rule also implements provisions of the Affordable Care Act (ACA) of 2010 that authorizes CMP’s for:
  1. Failure to grant the OIG timely access to records
  2. Ordering or prescribing while excluded
  3. Making false statements, omissions, or misrepresentations in an enrollment application
  4. Failure to report and return over payments, and
  5. Making or using a false record or statement that is material to a false of fraudulent claim
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Healthcare Compliance, Compliance Plan, compliance, healthcare audit, compliance program

Getting C-Suite to Buy Into Your Compliance Budget

Posted by Michael Rosen, ESQ on Thu, Jan 19, 2017

Getting Noticed:
Compliance is a tough job. It is thankless and often seen as the watchful eye. However, if ever there was a time to highlight the importance of compliance in healthcare, 2017 is the time.  Why? Well, just look at it from the perspective of the OIG or Department of Justice (DOJ).  

The OIG reported that in 2016, fraud and abuse was the number one problem facing healthcare when it comes to fines and punishment. Cases stemming from False Claims Act,  poor quality of care, fraudulent billing, and Stark violations dominated the news.  In the latest report on Fraud and Abuse in 2016, the combined efforts of the HHS OIG and DOJ won or negotiated over $2.5 billion in health care fraud judgments and settlements 2 , and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, in FY 2016 over $3.3 billion was returned to the Federal Government or paid to private persons.

 In FY 2016, investigations conducted by HHS’ Office of Inspector General (HHS-OIG) resulted in 765 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 690 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters. HHS-OIG also excluded 3,635 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs. Among these were exclusions based on criminal convictions for crimes related to Medicare and Medicaid (1,362) or to other health care programs (262), for patient abuse or neglect (299), and as a result of licensure revocations (1,448). HHS-OIG also issued numerous audits and evaluations with recommendations that, when implemented, would correct program vulnerabilities and save program funds.

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Healthcare Compliance, OIG, Long Term Care, compliance program

Healthcare Compliance Updates - New ROP Changes

Posted by Donna Thiel on Thu, Jan 12, 2017

As we all know the new Requirements of Participation (ROP) for Skilled Nursing Facilities (SNF) were published in the Federal Register on October 4, 2016 with the Phase 1 requirements going into effect on November 28, 2016.  The Requirements of Participation have not been significantly altered in nearly 25 years.  So as you can imagine, there are some significant changes that come with these new Requirements.

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